Over the next five years, the Johns Hopkins pre-doctoral AHRQ NRSA training program will prepare PhD health services researchers within the following three high priority areas: 1) Patient Safety, Quality and Outcomes: This area will focus on the multi-dimensional factors associated with attaining patient safety, quality and optimal outcomes of care delivery in diverse settings; 2) Transforming the Financing and Organization of Health Care Services: This area will focus on expanding our understanding of the ways in which our health care system's public and private financing mechanisms and organizational structure affect the efficiency, equity, and quality of care; and 3) Reducing Health Care Disparities for Vulnerable Populations: This area will focus on racial and ethnic minorities and populations disadvantaged by lack of access to health services (low income persons, uninsured children, residents of underserved areas) and vulnerable groups with complex care needs that often lead to poor care coordination and lower quality care. In the proposed program, we will place greater emphasis than in previous years on patient centered outcomes research and research related to the transformation of the health care system. Trainees will also gain a better appreciation for the secondary use of electronic health records and the role of health information technology in health services research. We will address patient/consumer, clinical and management perspectives. Our three areas of pre- doctoral training build from a common core of course work that emphasizes statistical, measurement, database/IT application, evaluation, and policy analysis skill sets. A significant addition to the program is the requirement of a Practicum that will allow students to acquire experience in research directed toward practical applications. This proposal presents a detailed set of core competencies and learning objectives that will provide important guidance for the students' training. The competencies are based in large part on the recommendations of an AHRQ sponsored national HSR core competencies conference our Department hosted in 2005. Our training program benefits from a large faculty with great breadth and depth in our priority areas and from the extensive research opportunities both at Johns Hopkins and in the Baltimore / Washington area. Our program will offer personalized small group and one-on-one support, mentoring and guidance to ensure a coordinated and cohesive training program experience for each of our trainees.